02344nas a2200241   4500000000100000008004100001260003400042653002400076653005700100653002100157653001700178653001100195653001300206653001800219653003100237100001500268700001600283700001700299700001500316245011900331520162700450022002502077       2024                            d  bOxford University Press (OUP)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aGeneral Medicine10aParasitology10aAfrica10aeconomic10aelephantiasis10aneglected tropical disease1 aSchurer JM1 aBayisenge U1 aHakizimana D1 aRafferty E00a‘My feet cannot stand on their own’: podoconiosis patient healthcare expenditures and income impacts in Rwanda3 a<p><strong>Background:</strong> Podoconiosis is a progressive and debilitating form of tropical lymphoedema endemic to Rwanda. Although the physical and psychological consequences are well known, few studies have evaluated the financial burden of podoconiosis.</p>

<p><strong>Methods:</strong> This cross-sectional, quantitative study aimed to characterize direct treatment costs and impacts on annual earnings among individuals living with podoconiosis. Participants from two highly endemic districts were invited to complete a survey focused on health-seeking history, insurance status, out-of-pocket costs and income changes. Direct treatment costs included medical expenditures (consultation, diagnostics, medication) and non-medical expenditures (food, transportation, accommodation).</p>

<p><strong>Results:</strong> Overall, 226 adults (≥18&nbsp;y of age) diagnosed with podoconiosis participated. Most had access to community-based health insurance (91.6%) but were unable to work (71.7%). Respondents sought care from health centres/posts (61.9%), hospitals (25.1%), traditional healers (5.8%) and/or community health workers (4.0%). On average, study participants paid US$32.50 (range US$0–779.23) annually, or 11.7% of their household salary, on podoconiosis treatments.</p>

<p><strong>Conclusions:</strong> This study demonstrates the significant financial burden of podoconiosis on individuals and their communities. Increased attention on integrating podoconiosis management into primary care systems and testing cost-effective solutions is needed to protect those who are most vulnerable.</p>
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